Are Psychiatric Medications Making Us Sicker?

By John Horgan

Three years ago, I was reminded in dramatic fashion of the chasm between
psychiatry and more-effective branches of medicine. My 14-year-old son, Mac,
while playing lacrosse, emerged from a collision with his right arm askew. I
drove him to a local hospital, where an orthopedic surgeon on duty
immediately diagnosed the injury: dislocated elbow. He gave Mac an oral and
local anesthetic and put him in a portable X-ray machine that showed Mac's
elbow joint on a screen, in real time. Watching the screen, the doctor
quickly snapped Mac's elbow back into place.

Overcome with gratitude to the doctor, I was leading my groggy son out of
the hospital when my cellphone rang. An old friend, whom I'll call Phil, was
on the line. He was in the psychiatric ward of a New York hospital, to which
his 16-year-old son had been committed. The boy, who was taking
antidepressants for depression, had threatened to commit suicide, not for
the first time. The doctors were recommending electroconvulsive therapy, or
ECT. Knowing that I had written about shock therapy and other psychiatric
treatments, Phil asked my opinion. The fact that Phil had called me, a mere
journalist, for advice in such a dire situation spoke volumes about the
troubles of modern psychiatry.

I first took a close look at treatments for mental illness 15 years ago
while researching an article forScientific
American.At the time, sales
of a new class of antidepressants, selective serotonin reuptake inhibitors,
or SSRI's, were booming. The first SSRI, Prozac, had quickly become the most
widely prescribed drug in the world. Many psychiatrists, notably Peter D.
Kramer, author of the best sellerListening
to Prozac,touted SSRI's as
a revolutionary advance in the treatment of mental illness. Prozac, Kramer
said in a phrase that I hope now haunts him, could make patients "better
than well."

Clinical trials told a different story. SSRI's are no more effective than
two older classes of antidepressants, tricyclics and monoamine oxidase
inhibitors. What was even more surprising to me—given the rave reviews
Prozac had received from Kramer and others—was that antidepressants as a
whole were not more effective than so-called talking cures, whether
cognitive behavioral therapy or even old-fashioned Freudian psychoanalysis.
According to some investigators, treatments for depression and other common
ailments work—if they do work—by harnessing the placebo effect, the tendency
of a patient's expectation of improvement to become self-fulfilling. I
titled my article "Why Freud Isn't Dead." Far from defending psychoanalysis,
my point was that psychiatry has made disturbingly little progress since the
heyday of Freudian theory.

In retrospect, my critique of modern psychiatry was probably too mild.
According toAnatomy of an
Epidemic(Crown Publishers,
2010), by the journalist Robert Whitaker, psychiatry has not only failed to
progress but may now be harming many of those it purports to help.Anatomy
of an Epidemichas been
ignored by most major media. I learned about it only after Marcia Angell,
former editor ofThe New
England Journal of Medicineand
now a lecturer on public health at Harvard, reviewed the book inThe
New York Review of Booksin
June. If Whitaker is right, American psychiatry, in collusion with the
pharmaceutical industry, is perpetrating what may be the biggest case of
iatrogenesis—harmful medical treatment—in history.

As recently as the 1950s, Whitaker contends, the four major mental
disorders—depression, anxiety disorder, bipolar disorder, and
schizophrenia—often manifested as episodic and "self limiting"; that is,
most people simply got better over time. Severe, chronic mental illness was
viewed as relatively rare. But over the past few decades the proportion of
Americans diagnosed with mental illness has skyrocketed. Since 1987, the
percentage of the population receiving federal disability payments for
mental illness has more than doubled; among children under the age of 18,
the percentage has grown by a factor of 35.

This epidemic has coincided, paradoxically, with a surge in prescriptions
for psychiatric drugs. Between 1985 and 2008, sales of antidepressants and
antipsychotics multiplied almost fiftyfold, to $24.2-billion. Prescriptions
for bipolar disorder and anxiety have also swelled. One in eight Americans,
including children and even toddlers, is now taking a psychotropic
medication. Whitaker acknowledges that antidepressants and other psychiatric
medications often provide short-term relief, which explains why so many
physicians and patients believe so fervently in the drugs' benefits. But
over time, Whitaker argues, drugs make many patients sicker than they would
have been if they had never been medicated.

Whitaker compiles anecdotal and clinical evidence that when patients stop
taking SSRI's, they often experience depression more severe than what drove
them to seek treatment. A multination report by the World Health
Organization in 1998 associated long-term antidepressant usage with a higher
rather than a lower risk of long-term depression. SSRI's cause a wide range
of side effects, including insomnia, sexual dysfunction, apathy, suicidal
impulses, and mania—which may then lead patients to be diagnosed with and
treated for bipolar disorder.

Indeed, Whitaker suspects that antidepressants—as well as Ritalin and other
stimulants prescribed for attention-deficit disorder—have catalyzed the
recent spike in bipolar disorder. Though bipolar disorder was relatively
rare just a half-century ago, reported rates of it have increased more than
a hundredfold, to one in 40 adults. Side effects attributed to lithium and
other common medications for bipolar disorder include deficits in memory,
learning ability, and fine-motor skills. Similarly, benzodiazepines such as
Valium and Xanax, which are prescribed for anxiety, are addictive;
withdrawal from these sedatives can cause effects ranging from insomnia to
seizures, as well as panic attacks.

Whitaker's analysis of treatments for schizophrenia is especially
disturbing. Antipsychotics, from Thorazine to successors like Zyprexa, cause
weight gain, physical tremors (called tardive dyskinesia) and, according to
some studies, cognitive decline and brain shrinkage. Before the introduction
of Thorazine in the 1950s, Whitaker asserts, almost two-thirds of the
patients hospitalized for an initial episode of schizophrenia were released
within a year, and most of this group did not require subsequent
hospitalization.

Over the past half-century, the rate of schizophrenia-related disability has
grown by a factor of four, and schizophrenia has come to be seen as a
largely chronic, degenerative disease. A decades-long study by the World
Health Organization found that schizophrenic patients fared better in poor
nations, such as Nigeria and India, where antipsychotics are sparingly
prescribed, than in wealthier regions such as the United States and Europe.

A long-term study by Martin Harrow, a psychologist at the University of
Illinois College of Medicine, found an inverse correlation between
medication for schizophrenia and positive, long-term outcomes. Beginning in
the 1970s, Harrow tracked a group of 64 newly diagnosed schizophrenics.
Forty percent of the nonmedicated patients recovered—meaning that they could
become self-supporting—versus 5 percent of those who were medicated. Harrow
theorized that those who were heavily medicated were sicker to begin with,
but Whitaker suggests that the medications may be making some patients
sicker.

Several possible objections to Whitaker's case against psychiatry come to
mind. First of all, as Harrow speculates, over time heavily medicated
patients may not fare as well as less-medicated patients because the former
truly are sicker. Also, the recent surge in mental disability may stem, at
least in part, from a decrease in the stigma associated with mental illness,
spurring more people to seek and obtain treatment and government assistance.
In her review, Marcia Angell called Whitaker's book "suggestive, if not
conclusive," which seems right to me. At the very least, Whitaker's claims
warrant further investigation.

Although Whitaker doesn't address electroconvulsive therapy, its persistence
strikes me as yet another symptom of the weakness of modern psychiatry. It
fell out of favor in the 1970s, in part because of its negative portrayal in
the 1975 filmOne Flew Over
the Cuckoo's Nest,and yet
about 100,000 Americans a year still receive ECT. Studies suggest that the
therapy can provide temporary relief from acute depression, but virtually
everyone who receives electroconvulsive therapy relapses within a year
without further treatment. Proponents claim that ECT has few significant
side effects, but this year an FDA panel ruled that ECT should remain
classified as a "high-risk" procedure because it can cause persistent memory
loss and other side effects. If SSRI's and other psychiatric medications
were truly effective, ECT would long ago have been tossed into the dustbin
of failed psychiatric treatments.

So what happened to Phil's son? When Phil called me, I told him that if my
son were suicidally depressed, I'd resist giving him shock treatment unless
doctors convinced me there was absolutely no alternative. Phil decided
against ECT, and his son, after being released from the hospital, gradually
stopped taking antidepressants too. He still struggles with depression, and
he smokes more marijuana than Phil would like. But he is healthy enough to
be starting college this fall.

John Horgan is director of the Center for Science Writings at the Stevens
Institute of Technology. His next book,The
End of War,will be published
by McSweeney's Books in November.